Provider Demographics
NPI:1669587523
Name:TANPHAICHITR, NATTHAVAT (MD)
Entity type:Individual
Prefix:
First Name:NATTHAVAT
Middle Name:
Last Name:TANPHAICHITR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20455 LORAIN RD
Mailing Address - Street 2:STE T-01
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-3494
Mailing Address - Country:US
Mailing Address - Phone:440-799-4224
Mailing Address - Fax:440-799-4228
Practice Address - Street 1:224 W EXCHANGE ST
Practice Address - Street 2:SUITE 330
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1704
Practice Address - Country:US
Practice Address - Phone:330-436-3150
Practice Address - Fax:330-436-3160
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.069619207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2248651Medicaid
OHH418280Medicare PIN
OHP00162095OtherRAIL ROAD MEDICARE
OHH228470Medicare PIN
OH000000191951OtherANTHEM
OH94714OtherQUALCHOICE
OH000000191951OtherANTHEM